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I'm thinking about a custom campaign that has a NPC character that has was born without an eye or left hand and hasn't been able replace them. He searches for these items to complete himself(and other reasons I'm not going to reveal). Vecna's appendages normally require one to lop off a hand or gouge out an eye. Would he be able to attune to them?
YES, I'd be the DM.
Also, to be fair to the picture in the DMG, Vecna's hand appears to have no bone at the wrist.
D&D was never meant to be a strict game where the rules are king. Leave that for competitive tabletop games like the war games it was born from.
If you need a character like that, let them. Should anyone call foul, kindly show them the golden rule.
Also, character's backstories aren't set in stone. It's what the character believes happened, but can we be truly sure? Did he naturally lose his eye and hand (or was born with), or perhaps some Wizard that worships Vecna set up the whole thing with his illusions and charms.
Think about that. For a character to obtain two artifacts out of a set, some fate shenanigans must be at work. I once heard an entire trilogy of books around a single artifact became very popular and even made it to the big screen as a trilogy of movies, fancy that!
I understand the OCD of having the story be truthful to the intentions of the designer to a tee. To do less is to compromise the vision.
I also know very well that I have one thing in my head, and then it becomes another entirely different thing on the computer screen / paper because I need to use those bony appendages to bash plastic cubes (or scratch carbon rods on plant fiber) to transmit them. Talk about a lossy data transfer protocol. (I really wish I could just plug an USB cable to my temple but I digress).
By the rules, if the facts stated are all true and immutable, you cannot have your character with the evil McGuffins. Don't let them win over the fun and a good story / campaign.
matszwecja has it right. There's magic that allows one to regrow an eye and a hand, only to have them excised for the sake of power.
Go ahead and make your campaign. Keep what the characters believe and what really happened separate. Life is full of inconsistencies due to unforeseen / unknown factors. Stories should mimic life and stir feelings, not be bastions of logic. If they can be both, great. If not, well. Shrug and move on.
As pointed out in other answers, RAW states that the self-mutilation is an important part of the attunement process, so the RAW answer would be "no". Of course as GM you can always just ignore this and go ahead with your idea anyway.
However, frame challenge:
The rules say this doesn't work but there is nothing in the rules that says either the character intending to undergo this "becoming whole" transformation or indeed the PCs (presumably) trying to stop them know this. In fact it's very likely that not even the most knowledgeable, wizened necromancers are aware of it.
After all, how else would this knowledge be even discovered other than trying it and seeing it fail?
And there's your campaign.
Based purely on mechanics contained in Vecna's Dossier, DnDBeyond supplement containing both of these artifacts, no, they cannot attune to them.
The wording explicitly says that the character must gouge their own eye out. Being born without eye is not gouging it out. The left hand must also be chopped off specifically at the wrist. If there is no wrist left in the left hand, they cannot chop it off.
That could possibly be circumvented in some way using magic to temporarily change creature shape into one that includes both body parts to be able to be replaced, but such a solution is starting to stretch the mechanics a lot.
This is your story arc for the overall campaign and you are not limited by the written rules when writing that. You are free to tell your story and use existing or homebrew ideas to do that. Trying to force your story into existing rules may be more difficult than necessary or creating weird inconsistencies. Simply write your overall story direction as you please and then provide any required info to your players.
If you are the DM, then you can tell this story how you'd like regardless of the specific rules. You are here to tell a story with your players and make it enjoyable for the whole table. Don't feel hamstrung by specifics for your story - just be clear that if you're changing how any player facing major mechanics work that your players understand.
When people are born with eye or hand defects, it is common for the body part to be present, but underdeveloped and not very useful, rather than fully absent. For instance, someone born with Symbrachydactyly may have little nubbins without bones, in place of fingers. However, that person still has a wrist and a hand, which could be cut off and replaced by the Hand of Vecna.
You could have this character have a hand and an eye that have been non-functional from birth, rather than fully absent. The storyline of "completing oneself" would then still make sense, and the mechanics would work by Rules As Written.
Of course, the suggestion of just mildly modifying how the hand and eye work is also perfectly reasonable.
